1285996264 NPI number — ADRIAN DIANA GOLDMAN D.O.

Table of content: ADRIAN DIANA GOLDMAN D.O. (NPI 1285996264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285996264 NPI number — ADRIAN DIANA GOLDMAN D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDMAN
Provider First Name:
ADRIAN
Provider Middle Name:
DIANA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285996264
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 MEDICAL CENTER BLVD
Provider Second Line Business Mailing Address:
CROZER-CHESTER MEDICAL CENTER, POB 1, SUITE 402
Provider Business Mailing Address City Name:
CHESTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19013-3955
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-447-6680
Provider Business Mailing Address Fax Number:
610-447-6677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 MEDICAL CENTER BLVD
Provider Second Line Business Practice Location Address:
CROZER-CHESTER MEDICAL CENTER, POB 1, SUITE 402
Provider Business Practice Location Address City Name:
CHESTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19013-3955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-447-6680
Provider Business Practice Location Address Fax Number:
610-447-6677
Provider Enumeration Date:
06/14/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  OT014930 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)